MEDICARE: DR. MELVIN M WAHL JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	A95817	CA
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	MD00047477	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0242786	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750399275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN M WAHL JR. MD

Provider Business Mailing Address
First Line	:	550 GAGE BLVD STE 101
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-9532
Country	:	US
Telephone Number	:	509-473-0637
Fax Number	:	509-627-2983

Provider Business Practice Location Address
First Line	:	1100 GOETHALS DR STE B
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-3301
Country	:	US
Telephone Number	:	509-942-3080
Fax Number	:	509-942-3085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	10/03/2024

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